Provider Demographics
NPI:1740844430
Name:SUBLIME THERAPEUTIC MASSAGE, INC.
Entity type:Organization
Organization Name:SUBLIME THERAPEUTIC MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:253-882-9752
Mailing Address - Street 1:1020 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-3105
Mailing Address - Country:US
Mailing Address - Phone:253-882-9752
Mailing Address - Fax:253-231-7949
Practice Address - Street 1:1020 E 34TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3105
Practice Address - Country:US
Practice Address - Phone:253-882-9752
Practice Address - Fax:253-231-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1407381908Medicaid